A hybrid salp swarm algorithm based on TLBO for reliability redundancy allocation problems.

A novel optimization algorithm called hybrid salp swarm algorithm with teaching-learning based optimization (HSSATLBO) is proposed in this paper to solve reliability redundancy allocation problems (RRAP) with nonlinear resource constraints. Salp swarm algorithm (SSA) is one of the newest meta-heuristic algorithms which mimic the swarming behaviour of salps. It is an efficient swarm optimization technique that has been used to solve various kinds of complex optimization problems. However, SSA suffers a slow convergence rate due to its poor exploitation ability. In view of this inadequacy and resulting in a better balance between exploration and exploitation, the proposed hybrid method HSSATLBO has been developed where the searching procedures of SSA are renovated based on the TLBO algorithm. The good global search ability of SSA and fast convergence of TLBO help to maximize the system reliability through the choices of redundancy and component reliability. The performance of the proposed HSSATLBO algorithm has been demonstrated by seven well-known benchmark problems related to reliability optimization that includes series system, complex (bridge) system, series-parallel system, overspeed protection system, convex system, mixed series-parallel system, and large-scale system with dimensions 36, 38, 40, 42 and 50. After illustration, the outcomes of the proposed HSSATLBO are compared with several recently developed competitive meta-heuristic algorithms and also with three improved variants of SSA. Additionally, the HSSATLBO results are statistically investigated with the wilcoxon sign-rank test and multiple comparison test to show the significance of the results. The experimental results suggest that HSSATLBO significantly outperforms other algorithms and has become a remarkable and promising tool for solving RRAP.

A Sustainable Model for Emergency Medical Services in Developing Countries: A Novel Approach Using Partial Outsourcing and Machine Learning.

INTRODUCTION: Unlike Western countries, many low- and middle-income countries (LMIC), like India, have a de-centralized emergency medical services (EMS) involving both semi-government and non-government organizations. It is alarming that due to the absence of a common ecosystem, the utilization of resources is inefficient, which leads to shortage of available vehicles and larger response time. Fragmentation of emergency supply chain resources motivates us to propose a new vehicle routing and scheduling model equipped with novel features to ensure minimal response time using existing resources. MATERIALS AND METHODS: The data set of medical and fire-related emergencies from January 2018 to May 2018 of Uttarakhand State in India was provided by GVK Emergency Management and Research Institute (GVK EMRI) also known as 108 EMSs was used in the study. The proposed model integrates all the available EMS vehicles including partial outsourcing to non-ambulatory vehicles like police vans, taxis, etc., using a novel two-echelon heuristic approach. In the first stage, an offline learning model is developed to yield the deployment strategy for EMS vehicles. Seven well researched machine learning (ML) algorithms were analyzed for parameter prediction namely random forest (RF), convolutional neural network (CNN), k-nearest neighbor (KNN), classification and regression tree (CART), support vector machine (SVM), logistic regression (LR), and linear discriminant analysis (LDA). In the second stage, a real-time routing model is proposed for EMS vehicle routing at the time of emergency, considering partial outsourcing. RESULTS AND DISCUSSION: The results indicate that the RF classifier outperforms the LR, LDA, SVM, CNN, CART and NB classifier in terms of both accuracy as well as F-1 score. The proposed vehicle routing and scheduling model for automated decision-making shows an improvement of 42.1%, 54%, 27.9% and 62% in vehicle assignment time, vehicle travel time from base to scene, travel time from scene to hospital, and total response time, respectively, in urban areas.

An integrated methodology to overcome barriers to climate change mitigation strategies: a case of the cement industry in India.

Cement is a basic requirement of today's society and is the only thing that humans consume more volume than water, but cement manufacturing is the most energy- and emission-intensive process. Hence, the cement industry is currently under pressure to reduce greenhouse gases (GHGs) emissions. Climate change mitigation strategies implemented in the industry leads to GHGs reduction, climate risks, pollutants, and another adverse impact on the environment. In order to implement climate change mitigation strategies in the cement industry, a careful analysis of barriers that hinder the emission reduction must be taken. However, most existing research on the barriers to mitigation measures is focused on developed countries. Among the most important emerging economies, India, the second-largest producer and consumer of cement, faces challenges to implement emission reduction measures. To bridge this gap, this paper identifies and evaluates the barriers and solutions to overcome these barriers in the context of India. This study employs a three-phase methodology based on fuzzy analytical hierarchy process (AHP) and fuzzy technique for order performance by similarity to ideal solution (TOPSIS) to identify barriers and solutions to overcome these barriers to climate change mitigation strategies adoption in Indian cement industry. Fuzzy AHP is employed to prioritize these barriers, and to rank solutions of these barriers, Fuzzy TOPSIS is employed. Ten Indian cement manufacturing industry is taken to illustrate the proposed three-phase methodology. Finally, the result of the analysis offers an effective decision support tool to the Indian cement industry to eliminate and overcome barriers to mitigation strategies adoption and build their green image in the market.

Outcome and complications of distal tibia fractures treated with intramedullary nails versus minimally invasive plate osteosynthesis and the role of fibula fixation.

INTRODUCTION: Distal tibia fractures have been managed conservatively as well surgically. A large number of implants have been used for surgical management of these fractures. No treatment method or implant has been proven to be superior to others. In this prospective comparative study, the complications and outcome of distal tibia fractures managed with intramedullary nails and minimally invasive plate osteosynthesis has been compared. Further, the role of fibula fixation in these fractures has been evaluated. MATERIALS AND METHOD: One hundred and fifty-four patients of distal tibia fractures with concomitant fibula fractures were randomized into 4 treatment groups based on predetermined inclusion criteria. Functional outcome in these groups was compared based on AOFAS score at 1 year. Intra-operative, post-operative parameters as well as radiological alignment, complications and the need for reoperation were also compared in these groups. RESULT: The functional outcome in all four treatment groups was similar. The duration of surgery and radiation exposure was higher with minimally invasive plate osteosynthesis. There was no improvement in outcome with plating of fibula. However, fixation of fibula improved the rotational alignment in distal tibia fractures. CONCLUSION: Although there is no difference in outcome of distal tibia fractures with either nailing or minimally invasive plating, nailing is recommended for closed displaced extraarticular fractures. Fixation of fibula should not be done routinely but should be reserved only for a few specific fracture patterns.

An integrated approach using AHP and DEMATEL for evaluating climate change mitigation strategies of the Indian cement manufacturing industry.

Concrete, a cement-based product is the highest manufactured and second highest consumed product after water on earth. Across the world, production of cement is the most energy and emission intensive industry hence, the cement industry is currently under pressure to reduce greenhouse gases emissions (GHGEs). However, reducing the GHGEs of the cement industry especially for developing country like India is not an easy task. Cement manufacturing industry needs to focus on significant climate change mitigation strategies to reduce the GHGEs to sustain its production. This study aims at identifying significant climate change mitigation strategies of the cement manufacturing industry in the context of India. Extant literature review and expert opinion are used to identify climate change mitigation strategies of the cement manufacturing industry. In the present study, a model projects by applying both AHP and DEMATEL techniques to assess the climate change mitigation strategies of the cement industry. The AHP technique help in establishing the priorities of climate change mitigation strategies, while the DEMATEL technique forms the causal relationships among them. Through AHP, the results of this research demonstrate that Fuel emission reduction is on top most priority while the relative importance priority of the main remaining factors is Process emission reduction - Electric energy-related emission - Emission avoidance and reduction - Management mitigation measures. The findings also indicate that the main factors, Process emission reduction, and Fuel emission reduction are categorized in cause group factors, while the remaining factors, Electric energy-related emission, Emission avoidance and reduction and Management mitigation measures are in effect group factors. Present model will help supply chain analysts to develop both short-term and long-term decisive measures for effectively managing and reducing GHGEs.

Computer navigation has no beneficial effect on blood loss and transfusion in sequential bilateral total knee Arthroplasty.

BACKGROUND: Bilateral total knee arthroplasty is associated with significant blood loss. Postoperative anaemia retards patients recovery, and blood transfusion increases the risk for major complications including infection. While strategies like hypotensive anaesthesia, tranexamic acid, bone wax and so on are useful to conserve blood, navigation has also shown to decrease blood loss and transfusion in unilateral knee arthroplasty. The aim of this study was to compare the blood loss and transfusion in sequential bilateral knee arthroplasty performed with or without navigation. MATERIALS AND METHODS: A retrospective case control cohort study of sequential bilateral knee arthroplasties was performed between 2 groups of 77 patients each, group N operated with navigation and group M operated without navigation. Both groups were matched for age, sex and body mass index. All patients were operated with similar surgical technique. The two cohorts were compared for blood loss calculated by three reliable methods. RESULTS: The preoperative haemoglobin (Hb) in group N was 12.83 ± 1.32 and group M was 12.58 ± 1.33 ( p = 0.24). The postoperative Hb taken day 4 before any blood transfusions was 8.60 ± 1.24 in group N and 8.54 ± 1.16 in group M ( p = 0.75). The average fall in Hb was 4.23 ± 1.08 in group N and 4.04 ± 1.19 in group M ( p = 0.31). There was no difference in blood loss between group N and M in all three methods; Gross equation ( p = 0.56), Hb dilution ( p = 0.24) and Hb balance ( p = 0.20). Need for blood transfusion was similar in group N and M ( p = 0.56). CONCLUSION: Blood loss and transfusion are equivalent in sequential bilateral total knee arthroplasty perform with or without navigation.

The Arid Melancholy-Netherton Syndrome With Protein Energy Malnutrition.

Netherton Syndrome (NS) is a rare autosomal recessive hereditary ichthyosiform disease with a classical triad comprising of an ichthyosiform dermatosis, hair shaft abnormalities and atopic diathesis. There is a mutation in a gene named Serine Protease Inhibitor Kazal type-5 (SPINK5); a new type of serine protease inhibitor involved in the regulation of skin barrier formation and immunity. Skin manifestations include, Ichthyosis Linearis Circumflexa (ILC), polycyclic and serpiginous, erythematous plaques with characteristic migratory, double-edged scale at the margins, or Congenital Ichthyosiform Erythroderma (CIE). Most of the patients have elevated immunoglobulin class E (IgE) and show atopic manifestations. Hair shaft abnormalities like pili torti and/or trichorrhexis nodosa, trichorrhexis invaginata, are seen. Here, we report a rare case of Netherton Syndrome having ILC and trichorrhexis nodosa with protein energy malnutrition in a five-year-old school going girl. She belonged to a poor socio-economic background and was worried about her physical appearance due to her skin lesions, causing psychosocial morbidity to her.

Eosinophilic panniculitis in a female child: An unusual presentation.

Eosinophilic panniculitis (EP) is characterized by prominent infiltration of subcutaneous fat with eosinophils. The etiology is diverse. This is not a disease but represents a reaction pattern that may occur in a variety of circumstances. The exact pathogenesis of the disease is still unclear. We present the case of a 6-year-old girl child who was diagnosed with EP.

Osteochondroma arising from the proximal fibula: a rare presentation.

Osteochondromas are commonly encountered benign tumours and they are characterized by cartilage capped bony growths that project from the surface of the affected bone. Osteochondromas tend to grow eccentrically rather than centrifugally. We are reporting a case of an 18-year-old male, who had presentation of a large, hard, irregular swelling over anterolateral aspect of his right leg. There was no neurovascular deficit in the extremity. Computed tomography showed that the origin of the tumour was probably proximal fibula. En-block excision of mass was done. A histopathological examination confirmed the diagnosis of a benign osteochondroma. Patient had uneventful recovery without any evidence of recurrence.

Citrobocter kasori spinal epidural abscess: a rare occurrence.

Pyogenic spinal epidural abscess Is an uncommon Infectious occurrence. Clinical prospects of pyogenic spinal epidural abscess are graver if not promptly diagnosed and treated appropriately. A case of spinal epidural abscess has been presented with sinus tract formation at L4-L5 level, of pyogenic aetiology that progressed to paraplegia over the course of the disease. MRI pointed towards an epidural abscess extending from T12 vertebral level to S1 vertebral level. Surgical decompression in the form of laminectomy and evacuation of pus was done and antibiotics were given according to culture and sensitivity. Histopathological analysis revealed the acute suppurative nature of the abscess. Citrobacter kasori was isolated on pus culture. Pyogenic epidural abscess with causative organism being Citrobacter kasori has least been documented.

Bullous fixed drug eruption to ciprofloxacin: a case report.

Adverse reactions to medications are extremely common and display a characteristic clinical morphology such as fixed drug eruption (FDE), Stevens-Johnson syndrome, urticaria, morbilliform exanthem, hypersensitivity syndrome, pigmentary changes, lichenoid, dermatitis, acute generalized exanthematous pustulosis, photosensitivity, vasculitis etc. Here we report a case of a 60 year old male who presented to us with multiple bullous eruptions over both the hands and feet after oral ingestion of ciprofloxacin.

Intramedullary spinal epidermoid cyst of the cervicodorsal region: A rare entity.

Intramedullary spinal epidermoid cysts are rare, with only few cases having been reported in the literature. We are reporting a case of a 10-year-old female child who presented with symptoms of meningitis with progressive paraparesis. Magnetic resonance imaging of the spine revealed an intramedullary epidermoid cyst from C6 to D5. Near-total excision of the tumor was performed. Histopathological report confirmed the diagnosis of epidermoid cyst. The patient showed progressive recovery.

Melanotic neuroectodermal tumor of infancy in oral cavity at unusual age.

The melanotic neuroectodermal tumor of infancy is an extremely rare, fast-growing but benign lesion, commonly occurring in the maxilla of children within the first year of life. Only about 380 cases of this particular tumor have been documented in the medical literature and very few of them have been reported to have occurred in late childhood. We describe here a relatively uncommon presentation of melanotic neuroectodermal tumor of infancy of maxilla arising from palatal gingiva of a 10 year-old female, its course and management by surgical excision with safe margins.